Judgement calls, personal space and (minimal) Wi-Fi

I write this one metre from where I sleep, it is also one metre form where my co-ordinator works on his laptop most days, and only a few minutes from where I consult for my colleague who is unwell. We all live and work on top of each other. This does led to convenience; the 10 step commute from my bed to morning meeting is convenient, as is the 30 step stroll to the hospital following this.

The lack of privacy is mostly part of the gig, something we have to accept with field work. However the lack of work/life divide is interesting. I have never had to work from home nor be on call from home. Now I work from where I live and am on call 24/7. I am sure my colleague setting up the mental health service here would draw some lessons about self care and boundaries which I am going to have to work out as I go along.

When I arrive at work some decision are fairly easy; with limited resources and very few consultation options you can only examine the patients, talk to the family and then make a decision based on diuretics, fluids, antibiotics or anti-malarias. However, this can be comparatively hard, the complexity of some of the patients is remarkable, I have treated more paediatric cardiac conditions in the past week than I have seen in many years of UK-based work. I have to reference textbooks (no google either) for conditions I am vaguely familiar with, and with the input of my more colleagues more experienced in some of the local conditions, we usually get to some kind of safe and appropriate treatment plan.

But the ethical decision are harder, the judgement calls have to be made. After a parent took there acutely sick child with a complex medical condition home (sickle cell and heart failure) without asking our advice, which both scarred and annoyed me in equal measure, but I had to start taking parents request for discharge seriously. So I ended up not only seeing some of the most unwell children in my career, but also discharging some of them too. But these are the judgement calls that have to be made. With a lack of diagnostics we have to make guesses and with parents having childcare and work commitments we want to make discharge as safe as possible. So decisions are balanced and weighed. More difficult than this is the use of resources, with only 2 inter-osseous needles left we will have to use what is often a basic emergency tool frugally.

Hospital life inevitably highlights the most negatives aspects of life, we are magnets for the worse stories and the bleakest outcomes. I have to remember to step outside the doors and see the magnificence of life that has sprung up in what was previously empty arid land. Right outside the door there are tea shops, a barber and some enterprising feller has turned up with a satellite dish for which he flogs sparse megabytes of Wi-Fi. But for us internet-starved international types it is a wonderful glimmer of contact with those I have only been away from for a few weeks, but what feels like so much longer. I have definitely squeezed a lot of life into the past week alone and it is nice to share this, albeit via a few short WhatsApp messages.

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